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1r ...-�..,'.._....�. _. ... , .. ..... .. . c . .,� ..:��.�ii�i'....�.:1"A.:•.:... :?+e:l,,t2�'i-.:..i:'v'a:rets N.V.Ilwc`�7 <br /> 1� i <br /> _ x <br /> STATE OF CALIFORNIA j <br /> ORIGINAL TWE RESOURCES AGENCY Do not fill to I�•r <br /> File with DWR DEPARTMENT OF WATER RESOURCCS g y 6 3 7 <br /> WATER WELL DRILLERS REPORT No. <br /> Notice of Intent Na State Well No. F. <br /> . Local Permit Na or Date 83-2936 Other Well No, <br /> Iw <br /> (1) OWNER: Name N i me r H?i (12) WELL LOC: Total depth 2 ft Completed depth 16n ft <br /> Address 801 r ' from ft to it. For.nation(Describe by color,character,size or material) <br /> City ;nn Fr a n r i Sri,r;; zip 1 0 -20 C I a y )' <br /> (2) LOCATION OF WELL(See instructions): 20' - <br /> 23 Sand <br /> Co-ulty San .1 n a n i i i rl Owners Weil Number J' —83 Clay <br /> Weil address if different from above 1 83 -89 Gravialt <br /> Tcvnship Range Section_ 9 -1 1 0 Clay <br /> u <br /> Distance from cities,roads,railroads,fences,eta M i MOrth nf 110 -1 1 4 r - <br /> ntirham Epr PH 114 -150 Clay <br /> 150 -152 arav <br /> 152 -225 Clay <br /> 225 -227 Gr ave <br /> (a) TYPE OF WORK: 227 —2 5 Q <br /> y <br /> New Well= Deepening ❑ <br /> Reconstruction ❑ <br /> a Reconditioning ❑ _ s; <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destntction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US _ <br /> Domesticooll^ _ <br /> Irrigation v V <br /> industrial ❑ _ _ f <br /> Test Weli O ❑ <br /> Munici ❑ _ 0 i <br /> O er <br /> t <br /> WELL LOCATION SKETCH ibe) <br /> 1 <br /> (S)EQUiP1EIJT: CRAv tCK Sfi <br /> .Rotary ;�. .•Re'nMI- ❑ No i <br /> Cable ❑ Air ❑ et 4 bare <br /> t Other ❑ Buck rom — <br /> (T)CASING INSTAL-ED.y (g) P• TI O _ <br /> Sted ❑ Plash.: tp T of on or size of r _ <br /> From D' I Gage or t <br /> ft f Wall t size - <br /> 0 <br /> 1-6 LNgz 160 1 1405cree - ` <br /> -(9) WELL SEAL: " +� <br /> Was aarface sanitary seal provided? Yes II No❑ If yes to depth 1-Q 9 ft <br /> ,T <br /> t Were strata seaiedagainst pollution? Yes ❑ No❑ Interval ft — <br /> method of sealing R F N <br /> InNTTFWork started—N.O-V-.--219-8 Completed 19^— ' <br /> (10) WATER LEVELS: WELL DRIL%ER'S STATEMENT: <br /> Depth of first water.it known ft. <br /> i This well was drilled under my jurisdiction and this report is true to the i <br /> Standing level after well completion 1 4 ft Lest of my.knowleft and 1w e <br /> ^t: (11) WELL TESTS: Signed <br /> (Weil Drdler) <br /> Was well test made? Yes ❑ No W If yea by whom? <br /> Typed test rump L'3 Bader ❑ Airlift ❑ NAME --I-A{&s— <br /> Depth to wale+;t start of test it At end of lest__ft ( erson irm.�r Corponuon y or Ivfit <br /> Discharge gal/min after hours Water temperature Address A�IpT_rr'y a __ s <br /> Cbemical analysis made? Yes❑ No M If yes by whom? Citv M n fl F510 , C.2 ZIP--a <br /> gigs <br /> Was electric made Yes ❑ No 00 If es attach copy to this report Lice' <br /> Na _Date of this report N n V 7 1 Q fl 8 <br /> �r OW11 iq fRflV t2-Mfl IF ADDITIONAL SPACri IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM M N7J3 y <br /> !r <br />